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Surgery is the primary treatment for stomach cancer. However, depending on the staging (extent of disease), additional therapeutics may be included in the treatment.
Typically, surgery involves removing most - or sometimes, all - of the stomach. When treating the disease in advanced stages (like if the cancer has spread to other areas of the body), radiation therapy and/or chemotherapy are often recommended to decrease the chance of recurrence.
Radiation and chemotherapy work in different ways: radiation beams precisely target a specific area with its highly defined beams, while chemotherapy goes throughout the body, interfering with the cancer cells’ ability to grow and reproduce
In cases where a patient’s stomach cancer appears not to have spread to distant organs, surgery remains the primary treatment for this disease. In most cases, the surgeon will remove at least half of the stomach (or, in some cases, the entire stomach), as well as the surrounding lymph nodes. For all but the earliest stages of stomach cancer, some form of chemotherapy will also usually be recommended, either before surgery or after surgery. Finally, radiation therapy is commonly used following surgery, especially when a patient’s stomach cancer is relatively large, or when multiple lymph nodes are involved with cancer.
Treatment for stomach cancer depends on the size and location of the tumor; the stage of the disease; and the individual's age and overall health. The goal of treatment for early-stage stomach cancer is to cure the disease. In advanced cases, when a cure is unlikely, the goal is to reduce pain and restore some quality of life (called palliative treatment). Surgical removal is the only curative treatment. Chemotherapy and radiation therapy may be used in addition to surgery or as palliative treatment.
Surgery: The type of surgery depends on the stage of the disease. Endoscopic mucosal resection may be used to treat early stomach cancer. This procedure involves removing only the tumor and surrounding tissue.
Gastrectomy is the most common treatment for stomach cancer. In this surgery, the entire stomach (total gastrectomy) or part of the stomach (partial or subtotal gastrectomy) is removed. Parts of nearby tissues or organs (such as the liver or spleen) may also be removed if the cancer has spread to those organs. In most cases, surrounding lymph nodes also are removed to prevent further spread of cancer. This is called a lymph node dissection. Surgery for cancer of the upper stomach (cardia) may require removal of the stomach and part of the esophagus.
Following total gastrectomy, the esophagus is attached directly to the small intestine. When a large section of the stomach is removed during partial gastrectomy, the surgeon reattaches the stomach to the esophagus or small intestine. The connection between these organs is called an anastomosis. Rarely, the new connections made between the ends of the stomach or esophagus and small intestine may leak.
Chemotherapy: Chemotherapy involves using prescription drugs to destroy cancer cells. This treatment may be used after surgery to destroy remaining cancer cells and prevent recurrence, called adjuvant treatment. Chemotherapy may be administered orally or intravenously (IV, or through a vein) and treatment is often administered on an outpatient basis. 5-fluorouracil (5-FU) is the most widely used agent in chemotherapy of gastric cancer alone or combined with other cytotoxic drugs.
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